| NPI | 1942774955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRONDA LANAE' JACKSON Psychotherapist 803-814-7115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 251B00000X Case Management | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-14 |